CARE HOMES FOR OLDER PEOPLE
Highfield House Sycamore Terrace Haswell Co. Durham DH6 2AG Lead Inspector
John Trainor Unannounced Inspection 13th March 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Highfield House Address Sycamore Terrace Haswell Co. Durham DH6 2AG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0191 526 1450 01429 297700 Susan Burns Mrs Marion Burns Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Old age, registration, with number not falling within any other category (25) of places Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Newly registered service Brief Description of the Service: Highfield House is a care home providing personal care and accommodation for up to 25 people who are over 65yrs of age. The home is registered to provide care for older people and older people with dementia. Highfield House is in a pleasant location on the outskirts of Haswell village. The home is close to the local communitys resources, including shops, pubs, club, post office, community health centre and other amenities. The ground floor accommodation has a large lounge and separate dining room, access to patio and lawned gardens. The majority of bedrooms, toilets and bathrooms are also located on the ground floor. The first floor has a small number of bedrooms and an additional bathroom, with both lift and stair access. Bedrooms are mainly single occupancy with the exception of one double. Nine have en-suite facilities. Fees at the time of inspection were £304.00 to 398.00 Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted 6 hours. During this visit records were inspected including care plans and health and safety records. Care practices were observed. People were spoken to including people resident, staff and management. There was a tour of the building. What the service does well: What has improved since the last inspection? What they could do better:
Records did not match the positive feedback from the people living in the home. People were not always assessed in enough detail to let them decide the home could meet their needs. The registered persons must make sure they have enough information on peoples needs to let them make a decision about whether they can look after the person. They must then confirm in writing they can look after someone to let the person make a decision about moving into the home. Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 6 Contracts/ terms and conditions needed revision to include a breakdown of fees and who was responsible for paying them. Some people did not have care plans. The most recent admissions had both poor assessment and no plan. The home must improve this area so people have their needs met in a planned and consistent way. Medication storage was not good with over ordering, poor storage and poor recording of administration. The home must improve the medication records so there is a clear audit trail and people can be sure they get the medicines they need when they need them. People did not have enough to occupy their time. There was no activities coordinator. One person said, “I just sit in here all day, it’s boring.” Improvement was needed to management systems to ensure health and safety matters were maintained and checked in a timely fashion. Doors were wedged open, this poses a fire risk and must stop unless they are propped open by devices approved by the fire officer for this purpose and which automatically close in the event of a fire. Bed rails were not fit for purpose or safe. Bed rails must only be used within a risk managed framework and within department of health guidelines. Water checks, legionella prevention and emergency lighting checks all needed improvement. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People were not always assessed in enough detail to let them decide the home could meet their needs. EVIDENCE: The new proprietors had issued all people with a contract but the contracts did not include a breakdown of fees. They needed revision to include the fee breakdown and who was responsible for paying them. Two out of three people did not have very thorough assessment recorded and there was little evidence the home was appropriate to meet their needs. People did not have confirmation in writing that the home could meet their needs after assessment and before they decided to move in. Some assessments sent by social care staff were out of date and there was no record of a managers assessment to supplement the information and make
Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 9 sure it was current. Outcomes in some of the assessments outlined the need for community facilities but the assessment had been used to place someone in residential care. Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs were not met in a planned way in all cases. EVIDENCE: People did have access to doctor and district nurses as needed. People said they were treated with dignity and respect and staff were seen to be polite and courteous. One person said they were cared for well. They were moved with the use of a hoist and said the staff respected their dignity. They said the staff were, “OK so far.” Another said they were happy with the service they received. A third said they were looking after them well and they could have a bath when they wanted, “I have only to ask and I get it straight away.” A relative thought the home was the best in the area, “couldn’t be better.”
Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 11 Records did not match the positive feedback from the people living in the home. Two out of three new admissions did not have care plans which detailed their needs and evaluated any changes to their condition. Care plans were not being reviewed frequently. Medication storage was poor with over ordering of stocks and items out of date in the medication cupboard. Recording sheets had gaps so it was unclear whether medication had been administered and if not why not? Handwritten changes and additions to medication record sheets were not signed and countersigned to show this was an accurate reflection of the prescribers instruction. Systems needed improving all medications in the home should have a clear audit trail. Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People liked the food but couldn’t do the things they liked to do and wanted more activities. EVIDENCE: People said the food was good they had a choice and the menu was varied and nutritious. One person said, “the food is excellent,” another said, “food’s great no grumbles at all.” Families and friends could visit when they wished. People did not have enough to occupy their time. There was no activities coordinator. “I just sit in here all day, it’s boring.” Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were protected by the homes complaints and adult protection policies and procedures. EVIDENCE: The home had a complaints procedure and a procedure and policy on the protection of vulnerable adults. There was a copy of the multi agency strategy on adult abuse telling people local procedures to deal with potential abuse. A relative felt the new proprietors were approachable and they would feel free to complain if they had the need to do so. Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People lived in a clean and comfortable home but improvements were needed to maintaining safety. EVIDENCE: The home was clean. People were happy with their rooms. One person said, “my room is kept clean enough and warm enough.” They were clean and nicely decorated. Communal areas had benefited from improvement since the new proprietors had taken over. There was a new boiler and some new windows. Some windows still needed replacing but there was a plan to do this. Carpets had been replaced in communal areas. There was a newly fitted kitchen which appeared to be of a high standard. There was liquid soap and paper towels to promote good infection control. Blinds and curtains were being
Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 15 cleaned to make things nicer for people. The fire alarm and nurse call system had been replaced. Communal bathrooms had toiletries left in them which were not labelled as belonging to anyonme and so could have been used communally. In one bathroom disposable razors had been left as well as 3 sets of communal nail clippers. Nail clippers must not be used communally unless they are sterilised in between people. Disposable razors must be safely disposed of after use. Doors were being routinely wedged open throughout the home. Doors must not be wedged unless by devices approved by the fire office for this purpose. One person was using bed rails which were not fit for purpose and posed a potential risk. Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff were deployed in sufficient number and with sufficient skill to meet the needs of the people resident. EVIDENCE: 100 of the staff team were trained to NVQ2 or above with senior staff trained to NVQ 3. People said the staff were on hand if they needed them and cared for them well. Staff were recruited safely with police checks and references. Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People would benefit from improved management in the home. EVIDENCE: The manager was new. Was qualified with a HNC in care and the registered managers award. She had not applied to register with the Commission for Social Care Inspection. Some health and safety checks had been done. There was a new fire alarm system. The electrical hard wiring certificate was up to date to demonstrate safety of the installation. Portable appliances had been checked for safety. And the nurse call system had been checked in March
Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 18 2007. The passenger lift had been serviced in February 2007. The home had appropriate insurance. However regular checks which should have taken place on water temperatures, emergency lighting and fire alarms had not been done since the beginning of February 2007 and were not taking place weekly as planned. Hoists were due for a service and had not been done. An appointment was made at the time of inspection by the proprietors to have them serviced. Fire training had not been done since January 2006 and a fire risk assessment was needed after consultation with the fire officer. Doors were being wedged open in the home and bed rails used when not fit for purpose. Service user money records were not all accurate and checks had been conducted and signed for accuracy when they were not. The procedure was not being correctly followed. These checks must be robust to protect service user money. Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 1 3 X 1 Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP2 Regulation 5 Requirement Timescale for action 30/04/07 2 OP3 3 OP7 4 OP9 Contracts and terms and conditions must be revised to make sure they give a breakdown of fees and who is responsible for paying them. 14 People must not be admitted to 30/04/07 the home without an up to date assessment of need, by a person qualified to do so, so the home can decide whether they can look after someone properly. The home must then confirm in writing they can look meet the persons needs before they make a decision to move in. 15 People must have a care plan 30/04/07 which details their needs and how they are to be looked after. Plans must include risk assessment and risk management. 13 (2 & 4) Medication must be stored 30/04/07 correctly. Record sheets must be signed when medication is either administered or omitted. Hand written changes to Medication Administration Record sheets must be signed and counter signed to confirm it is an
DS0000068092.V330355.R01.S.doc Version 5.2 Highfield House Page 21 5 OP35 16 (2(l)) 6 OP38 13 (4(c)) 7 8 OP38 OP38 23 (4) 23 (4) accurate reflection of the prescribers instruction. Procedures must be followed to ensure service user money held by the home is accurately recorded and audited. A service user was being cared for using bed rails with bumpers. The care file showed risk assessment and indicated use of rails but the rails used were not fit for purpose. They were not suitable for use with the pressure reliving mattress and were not fitted correctly, therefore posing a risk. Bed rails must only be used if safe and within department of health guidelines Doors must not be wedged open unless by devices approved by the fire officer for this purpose. The home must produce a fire risk assessment after consultation with the fire officer. 30/04/07 13/03/07 13/03/07 31/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP31 Good Practice Recommendations The manager should make application to register with the Commission for Social Care Inspection. Highfield House DS0000068092.V330355.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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